Spine Surgery Through the Belly Button!
Elizabeth Hofheinz, M.P.H., M.Ed. • Fri, September 29th, 2017
The belly button may not seem to be a dynamic participant in the workings of the body. It has a new life purpose, however, thanks to a visionary entrepreneur and a talented spine surgeon.
Raymond Cloutier is founder and president of NovApproach Spine, LLC. Seven years ago he attended a meeting where he observed a company presentation on a retractor for gastrointestinal surgery. “These surgeons are going through the umbilicus,” he thought. “Wouldn't it be great if what they have learned could be applied to spine surgery?”
Sang Hyeop Jeon, M.D. is a spine surgeon at the Spine Health Wooridul Hospital in Busan, Korea. Along with his talented colleagues, he has breathed life into Cloutier’s vision and has now performed approximately 300 surgeries using the umbilicus as the access point.
Dr. Jeon, who has trained four other surgeons on the procedure, recently presented the results of the first 35 of his patients at the Society for Minimally Invasive Spine Surgery (SMISS).
“I call the procedure TULIF, as in ‘Trans-Umbilical Lumbar Interbody Fusion.’” Said Dr. Jeon to OTW.
Spine surgeons, in the mid ‘80s and early ‘90s, attempted anterior spine surgery laparoscopically and placed a camera through the umbilicus; however, the actual procedure on the spine was not done through this orifice. This is completely new.”
“I had been performing anterior lumbar interbody fusion using a small 4 cm long incision near the belly button. The skin of the umbilicus is recessed and convoluted, so that when I reduce the incision length (2-3 cm) and move it to the umbilicus, the circumference increases. This is a key factor in how this technique works. And, while the location of the umbilicus varies from person to person, it is usually around L4/5 or L3/4. Once a small incision at the umbilicus is made, the rest of the procedure is the same as the regular retroperitoneal approach. And patients are beyond thrilled to see that they have no scarring after the surgery."
Several precautions are necessary, says Dr. Jeon. “This technique cannot be safely performed on obese patients. Also, good alignment between the target disc and the umbilicus is necessary. Although the incision itself is small, the surgical opening must be large enough to perform an anterior lumbar interbody fusion (ALIF) procedure in a normal fashion. For example, careful vascular retraction with good illumination is critical.”
“To improve the surgical exposure and visibility, I use a flexible circumferential wound protector, a light source attached to one of the retractors and a pneumatic power-controlled retractor that is fixed to the operating table.”
And what are spine surgeons and industry executives saying about Dr. Jeon’s SMISS presentation—A Novel Scar-less Surgical Approach to the Spine via the Umbilicus? Raymond Cloutier surveyed the audience and heard these comments:
- “I noticed the title of the paper and made sure I attended”
- “That was really cool”
- “I think this is very possible to do in my OR”
- “I will present this to my team when I get home next week to get their thoughts”
- “Please send me more information about this”